Diagnostically Challenging Multifocal Penile Epithelioid Hemangioma Successfully Treated With Doxorubicin Hydrochloride.

ABSTRACT: Epithelioid hemangioma (EH), also known as angiolymphoid hyperplasia with eosinophilia, is an unusual vascular proliferation that tends to manifest in the head and neck region. Its occurrence on the penis is rare, with only scarce reported cases in the literature. The histopathological examination of this condition poses a challenge because it shares similarities with other entities, such as epithelioid hemangioendothelioma, epithelioid angiosarcoma, cutaneous epithelioid angiomatous nodule, or Kaposi sarcoma (KS). The infrequency of EH in penile locations underscores the need for accurate diagnostic differentiation and tailored treatment strategies for this atypical presentation. This case report highlights a rare instance of multifocal penile EH. The patient's lesions exhibited distinctive histopathologic features, with extensive eosinophilic infiltration, presence of necrosis, and infiltration to subcutaneous fat. The patient was treated with doxorubicin, a chemotherapy drug, with a very good response. This successful therapeutic outcome underscores the potential efficacy of doxorubicin in the management of multifocal penile EH. The comprehensive analysis of this case contributes to our understanding of the clinical presentation, histopathologic features, and treatment modalities for this rare penile tumor, providing valuable insights for future clinical considerations.

Fractional Carbon Dioxide Laser is Effective in Amelioration of Pruritus in Primary Cutaneous Amyloidosis: A Clinical and Biochemical Study.

BACKGROUND AND OBJECTIVES: Primary cutaneous amyloidosis (PCA) is a pruritic disease characterized by amyloid deposition in the skin. Interleukin-31 (IL-31) is a pruritus-mediating cytokine. Fractional carbon dioxide (CO2 ) laser has shown efficacy in the treatment of PCA regarding the clinical appearance, histological pattern, and pruritus. The aim of this study is to assess the effect of fractional CO2 laser on pruritus associated with PCA, and analyze whether this effect is related to IL-31 and IL-31 receptor (R) expression. STUDY DESIGN/MATERIALS AND METHODS: The study included 24 patients with PCA and 24 healthy controls. Each patient received four fractional CO2 laser sessions, 4 weeks apart, using the superficial ablative mode. Skin biopsies were taken from patients before and after treatment, as well as controls, for assessment of IL-31 and IL-31R by real-time polymerase chain reaction. RESULTS: Treatment resulted in significant improvement of all clinical parameters, including pruritus (P < 0.001). Patients before treatment had significantly higher IL-31 and IL-31R than controls (P = 0.000 for both). In addition, there was a statistically significant decrease in IL-31 and IL-31R after treatment than their values before treatment (P = 0.000 for both). CONCLUSION: This study confirms the therapeutic efficacy of fractional CO2 laser in treatment of PCA. Reduction of IL-31 and its receptor seems to be one of the involved mechanisms; however, its relation to improvement of pruritus is still not clear. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Assessment of vitamin D receptors in alopecia areata and androgenetic alopecia.

BACKGROUND: Alopecia areata (AA) is a frequent autoimmune disease, the pathogenesis of which is still unknown. Androgenetic alopecia (AGA) is a noncicatricial type of patterned hair loss. Expression of vitamin D receptors (VDRs) on keratinocytes is essential for maintenance of normal hair cycle, especially anagen initiation. OBJECTIVE: To assess VDRs in the skin and blood of AA and AGA patients, in order to evaluate their possible role in these hair diseases. METHODS: This study recruited 20 patients with AA, 20 patients with AGA, and 20 healthy controls. Blood samples and lesional scalp biopsies were taken from all participants for detection of VDR levels. RESULTS: Serum and tissue VDR levels were lower in AA as well as AGA patients when compared to controls (P = 0.000). Serum and tissue VDR were positively correlated in each group. Tissue VDR was significantly lower in female patients with AA than males (P = 0.046) although serum and tissue VDR levels were significantly higher in female AGA patients than males (P = 0.004). CONCLUSION: This study suggests an important role for VDR in the pathogenesis of AA and AGA through documenting lower serum and tissue VDR levels in AA and AGA patients in comparison with controls.

Assessment of tissue levels of dickkopf-1 in androgenetic alopecia and alopecia areata.

BACKGROUND: Androgenetic alopecia (AGA) is the commonest form of hair loss in men. Alopecia areata (AA) is an organ-specific autoimmune disease. Studies revealed that Dickkopf 1 (DKK-1), a powerful suppressor of the Wnt/ß-catenin signaling pathway, induced anagen-to-catagen transition in mice. Moreover, in vitro studies suggested that DKK-1 played a role in dihydrotestosterone (DHT)-induced balding. AIM: To evaluate the tissue levels of DKK-1 in patients with AGA and AA, to assess its possible role as a pathogenetic mechanism in both disorders. METHODS: This study included 24 patients with AGA, 31 patients with AA, and 33 healthy controls. Scalp biopsies were taken from all participants for the detection of tissue DKK-1 levels. RESULTS: Tissue DKK-1 levels were significantly higher in patients with AGA than in controls (P = 0.000) as well as in patients with AA than in controls (P = 0.001). In addition, they were significantly higher in patients with AGA than in patients with AA (P = 0.000). DKK-1 was higher in male than in female patients with AGA. DKK-1 was negatively correlated with disease duration in AGA. CONCLUSION: In conclusion, this study suggests an important role for DKK-1 in the pathogenesis of AGA and AA through documenting higher tissue DKK-1 levels in patients with both hair disorders compared to controls and suggests that DKK-1 may be a promising therapeutic target for these hair diseases.

Efficacy of different modes of fractional CO2 laser in the treatment of primary cutaneous amyloidosis: A randomized clinical trial.

BACKGROUND: Primary cutaneous amyloidosis (PCA) comprises three main forms: macular, lichen, and nodular amyloidosis. The current available treatments are quite disappointing. OBJECTIVES: Assess and compare the clinical and histological changes induced by different modes of Fractional CO2 laser in treatment of PCA. PATIENTS AND METHODS: Twenty five patients with PCA (16 macular and 9 lichen amyloidosis) were treated by fractional CO2 using; superficial ablation (area A) and deep rejuvenation (area B). Each patient received 4 sessions with 4 weeks intervals. Skin biopsies were obtained from all patients at baseline and one month after the last session. Patients were assessed clinically and histologically (Congo red staining, polarized light). Patients were followed-up for 3 months after treatment. RESULTS: Both modes yielded significant reduction of pigmentation, thickness, itching, and amyloid deposits (P-value < 0.001). However, the percentage of reduction of pigmentation was significantly higher in area A (P-value = 0.003). Pain was significantly higher in area B. Significant reduction in dermal amyloid deposits denotes their trans-epidermal elimination induced by fractional photothermolysis. CONCLUSION: Both superficial and deep modes of fractional CO2 laser showed comparable efficacy in treatment of PCA. Superficial mode being better tolerated by patients, is recommended as a valid therapeutic option.

Reduction of RANTES expression in lesional psoriatic skin after narrow band ultraviolet therapy: a possible marker of therapeutic efficacy.

BACKGROUND: The regulated upon activation, normal T cell expressed and secreted (RANTES) production in psoriatic lesions may amplify the inflammation in these lesions. Narrow band ultraviolet B (NB-UVB), a therapeutic modality for psoriasis, affects the expression of inflammatory cytokines and chemokines. OBJECTIVE: Our aim was to evaluate RANTES mRNA expression in skin lesions of psoriasis before and after NB-UVB phototherapy. METHODS: This study included 25 psoriatic patients who received 24 sessions of NB-UVB. Skin biopsies were taken before and after phototherapy for real time PCR evaluation of RANTES mRNA. RESULTS: The relative quantitation values (RQ) of RANTES mRNA expression was significantly reduced after treatment. A significant negative correlation was found between pre-treatment RQ RANTES mRNA expression and post-treatment PASI score. We found a significant negative correlation between dRQ RANTES mRNA expression (difference between RQ RANTES mRNA expression before and after phototherapy) and PASI score after phototherapy. We found significant negative correlations between pre-treatment RQ RANTES mRNA expression and both initial response session number and total NB-UVB dose at the end of phototherapy. CONCLUSION: NB-UVB reduces RANTES mRNA expression in psoriatic lesions. Pre-treatment RQ RANTES mRNA expression could be considered as a marker for clinical improvement and NB-UVB phototherapy efficacy.

Medical ethics educational improvement, is it needed or not?! Survey for the assessment of the needed form, methods and topics of medical ethics teaching course amongst the final years medical students Faculty of Medicine Ain Shams University (ASU), Cairo, Egypt 2010.

INTRODUCTION: In the process of our faculty gaining accreditation, the debate concerning the necessity for initiating an integrated course in which medical ethics course is implemented have arouse. Arguments concerning what should this course include, the best timing for this course to be applied, how it should be taught, planned for and mostly for what the students are interested to get out of it. GOAL: The main purpose of this work is to identify the ethical needs and ethical dilemmas freshly graduated medical students face at the beginning of their training and their suggestions to seek better educational approaches that can be applied in teaching medical ethics proposed by the medical students themselves throughout the teaching process and after graduation. METHODS: It seemed rather appropriate at this stage to carry out an evaluation survey assessing the needs for medical ethics teaching course through the exploration of the opinions of medical students and freshly graduated doctors on ethical issues through a simple survey by using an open ended question questionnaire designed to fulfil the study targeted requirements. RESULTS: 100 volunteers (n = 100) randomly chosen from the fifth year students of our faculty of medicine ASU who had recently studied ethics course in the fourth year (n = 20), interns both junior and senior residents in El Demerdash hospitals (n = 80). 25 questionnaires were excluded due to inappropriate or missing answers resulting in 75% response rate. 60% of the surveyed group favored an integrated ethics course taught throughout the whole academic years study. 56% chose the practical teaching method with problem solving strategies for the daily arising confusing ethical issues to be the best way to teach the course. While 53.4% thought that stuff specialized in medico legal issues were best to teach this course. As regards the highly confusing ethical dilemmas in which they were interested in getting updated feedback about: Confidentiality, doctor-patient relationship and informed consent came first by 69.3%. CONCLUSIONS: This study revealed the essential need for a model medical ethics curriculum that responds to students' concerns in addition to providing basic training in moral reasoning and ethical decision making to be applied both horizontally and vertically across the whole years of medical school. RECOMMENDATIONS: A Simple booklet containing recent version of the Egyptian code of ethics, common ethical dilemmas and recently evolving ethical issues should be available for all newly graduated health professionals.

Elevated serum levels of a proliferation-inducing ligand in patients with systemic sclerosis: possible association with myositis?

OBJECTIVE: A proliferation-inducing ligand (APRIL) is a new member of the tumour necrosis factor family which is intimately connected to the regulation of cellular pathways. The aim of this study was to assess serum concentrations of APRIL in systemic sclerosis patients, and to correlate them with the main clinical and serological features of the disease. METHODS: Sera from 35 patients with systemic sclerosis, 25 had limited cutaneous and 10 had diffuse cutaneous subtypes, and 35 normal healthy subjects were assayed for APRIL by Enzyme Linked Immunosorbant Assay. Demographic, clinical, autoantibodies and serological data were prospectively assessed. RESULTS: Serum APRIL concentrations were higher in patients with systemic sclerosis and in both its subtypes compared to the healthy controls (p<0.0001 in all). Patients with elevated APRIL levels had significantly higher incidences of myositis than those with normal levels (p=0.04). We did not find significant differences in other organ involvement prevalence between systemic sclerosis patients with elevated vs. normal APRIL levels. In addition, the frequencies of autoantibodies (i.e., anti-topoisomerase I, anti-centromere) were comparable between both groups. Serum APRIL levels were correlated with serum γ-globulins concentrations (r=0.404, p=0.016) but not with C-reactive protein, skin score, nor pulmonary functions. Serum APRIL was also correlated with creatine kinase levels only in systemic sclerosis patients with myositis (r=0.786, p=0.02). CONCLUSION: Our preliminary results suggest increased serum APRIL levels in systemic sclerosis patients, particularly in those associated with myositis and hypergammaglobinemia. To confirm our results, we propose that larger scale, multicentre studies with longer evaluation periods are needed.

Leukocytoclastic vasculitis and necrolytic acral erythema in patients with hepatitis C infection: do viral load and viral genotype play a role?

BACKGROUND: Leukocytoclastic vasculitis (LCV) and necrolytic acral erythema (NAE) are skin disorders associated with hepatitis C virus (HCV) infection. However, they have not been found to occur simultaneously in the same patient. OBJECTIVE: We sought to analyze the role of serum HCV-RNA levels and HCV genotype in the pathogenesis of both LCV and NAE in an attempt to assess whether these two parameters play a role in mutual exclusivity of LCV and NAE in the same patient. METHODS: The study included 11 patients with LCV and 13 with NAE, all of whom were infected with HCV. All 24 patients were evaluated for the quantitative levels of HCV-RNA, using real-time polymerase chain reaction. HCV genotyping was performed on 10 patients in each group (N = 20). RESULTS: Patients with LCV had a higher prevalence of moderate and high levels of HCV-RNA viremia (P = .038) than those with NAE. However, there was no significant difference in HCV genotype between LCV and NAE groups (P = .211). LIMITATIONS: Small number of cases is a limitation. CONCLUSION: Viral load seems to play a role in determining the response of the skin to HCV infection. High levels of HCV viremia were found to be significantly associated with LCV but not with NAE. HCV viremia may play a role in the development of LCV in HCV-infected patients.